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DRUG INFORMATION ROUNDS

Allopurinol as a Cardioprotectant During Coronary Artery Bypass Graft Surgery

Student, School of Pharmacy, University of Wisconsin–Madison, Madison, WI

William F Tanke, BSPharm

Clinical Pharmacist, University of Wisconsin Hospitals and Clinics, Madison

J Jason Sims, PharmD

Assistant Professor (Center for Health Sciences), School of Pharmacy, University of Wisconsin–Madison; Clinical Pharmacist, University of Wisconsin Hospitals and Clinics

Reprints: J Jason Sims PharmD, School of Pharmacy, University of Wisconsin–Madison, 777 Highland Ave., Madison, WI 53705-2222, FAX 608/265-5421, jjsims{at}pharmacy.wisc.edu

OBJECTIVE: To examine the role of allopurinol as a cardioprotectant during coronary artery bypass graft (CABG) surgery.

DATA SOURCES: A search of MEDLINE (1966–October 2002) was performed using the following terms: allopurinol, xanthine oxidase, oxygen free radical, and coronary artery bypass. References evaluated were limited to English-language and human studies, yielding 41 citations, 13 of which were found suitable. The 5 largest studies are discussed.

DATA SYNTHESIS: Multiple studies with various doses have evaluated the effects of allopurinol on outcomes in CABG patients. These studies found that allopurinol can reduce in hospital mortality, improve cardiac performance, reduce incidence of arrhythmias, reduce markers of ischemia and free-radical generation, and reduce the need for inotropic support. However, these findings were not consistent between all studies.

CONCLUSIONS: Allopurinol may reduce the incidence of CABG complications. Although the optimal dose has not been determined, reviewed literature suggests that patients should receive at least 600 mg one day prior to surgery, as well as at least 600 mg on the day of surgery.

Key Words: allopurinol, coronary artery bypass graft surgery, oxygen free radicals

Published Online, September 18, 2003. www.theannals.com, DOI 10.1345/aph.1D023

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